Provider Demographics
NPI:1649894650
Name:HILL, RENITA C (LPN)
Entity type:Individual
Prefix:
First Name:RENITA
Middle Name:C
Last Name:HILL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 ROBERTA WAY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35214-1743
Mailing Address - Country:US
Mailing Address - Phone:205-209-9215
Mailing Address - Fax:205-905-6263
Practice Address - Street 1:1512 CENTER POINT PKWY STE 101
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35215-5675
Practice Address - Country:US
Practice Address - Phone:205-209-9215
Practice Address - Fax:205-905-6263
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2-062089164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL851411423Medicaid